Apprehension-Based Training: A Novel Treatment Concept for Anterior Shoulder Dislocation - A Case Report

Area of Science:

• Orthopedics
• Sports Medicine
• Rehabilitation Science

Background:

• Recurrent anterior shoulder dislocation (ASD) often necessitates surgical intervention due to high recurrence rates with conservative management.
• Current rehabilitation protocols may not sufficiently enhance shoulder stability, potentially limiting adaptive recovery strategies.
• Apprehension-based training (ABT) is a novel concept derived from the supine moving apprehension test (SMAT) for ASD management.

Observation:

• A 23-year-old male with bilateral recurrent ASD participated in a 17-week ABT program.
• The program involved progressive exposure to anterior instability loads mirroring the SMAT movement pattern.
• Outcome measures included the Western Ontario Shoulder Instability Index (WOSI), Patient-Specific Functional Scale (PSFS), Tampa Scale of Kinesiophobia, SMAT performance, and muscle strength.

Findings:

• Clinically significant improvements were observed in quality of life (WOSI) and shoulder function (PSFS).
• Kinesiophobia decreased, and SMAT performance and shoulder internal rotator strength increased beyond minimal detectable change.
• Improvements in quality of life and function were sustained at 4-month follow-up, with a reported decrease in ASD events.

Implications:

• ABT, utilizing gradual exposure to instability loads, shows promise for enhancing the management of recurrent ASD.
• This approach may offer a viable conservative treatment option, potentially reducing the need for surgery.
• Further research and clinical trials are warranted to validate the efficacy of ABT in a larger patient cohort.